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Allergic Bronchopulmonary Aspergillosis: A Perplexing Clinical Entity
In susceptible individuals, inhalation of Aspergillus spores can affect the respiratory tract in many ways. These spores get trapped in the viscid sputum of asthmatic subjects which triggers a cascade of inflammatory reactions that can result in Aspergillus-induced asthma, allergic bronchopulmonary...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Korean Academy of Asthma, Allergy and Clinical Immunology; The Korean Academy of Pediatric Allergy and Respiratory Disease
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853505/ https://www.ncbi.nlm.nih.gov/pubmed/27126721 http://dx.doi.org/10.4168/aair.2016.8.4.282 |
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author | Shah, Ashok Panjabi, Chandramani |
author_facet | Shah, Ashok Panjabi, Chandramani |
author_sort | Shah, Ashok |
collection | PubMed |
description | In susceptible individuals, inhalation of Aspergillus spores can affect the respiratory tract in many ways. These spores get trapped in the viscid sputum of asthmatic subjects which triggers a cascade of inflammatory reactions that can result in Aspergillus-induced asthma, allergic bronchopulmonary aspergillosis (ABPA), and allergic Aspergillus sinusitis (AAS). An immunologically mediated disease, ABPA, occurs predominantly in patients with asthma and cystic fibrosis (CF). A set of criteria, which is still evolving, is required for diagnosis. Imaging plays a compelling role in the diagnosis and monitoring of the disease. Demonstration of central bronchiectasis with normal tapering bronchi is still considered pathognomonic in patients without CF. Elevated serum IgE levels and Aspergillus-specific IgE and/or IgG are also vital for the diagnosis. Mucoid impaction occurring in the paranasal sinuses results in AAS, which also requires a set of diagnostic criteria. Demonstration of fungal elements in sinus material is the hallmark of AAS. In spite of similar histopathologic features, co-existence of ABPA and AAS is still uncommon. Oral corticosteroids continue to be the mainstay of management of allergic aspergillosis. Antifungal agents play an adjunctive role in ABPA as they help reduce the fungal load. Saprophytic colonization in cavitary ABPA may lead to aspergilloma formation, which could increase the severity of the disease. The presence of ABPA, AAS, and aspergilloma in the same patient has also been documented. All patients with Aspergillus-sensitized asthma must be screened for ABPA, and AAS should always be looked for. |
format | Online Article Text |
id | pubmed-4853505 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | The Korean Academy of Asthma, Allergy and Clinical Immunology; The Korean Academy of Pediatric Allergy and Respiratory Disease |
record_format | MEDLINE/PubMed |
spelling | pubmed-48535052016-07-01 Allergic Bronchopulmonary Aspergillosis: A Perplexing Clinical Entity Shah, Ashok Panjabi, Chandramani Allergy Asthma Immunol Res Review In susceptible individuals, inhalation of Aspergillus spores can affect the respiratory tract in many ways. These spores get trapped in the viscid sputum of asthmatic subjects which triggers a cascade of inflammatory reactions that can result in Aspergillus-induced asthma, allergic bronchopulmonary aspergillosis (ABPA), and allergic Aspergillus sinusitis (AAS). An immunologically mediated disease, ABPA, occurs predominantly in patients with asthma and cystic fibrosis (CF). A set of criteria, which is still evolving, is required for diagnosis. Imaging plays a compelling role in the diagnosis and monitoring of the disease. Demonstration of central bronchiectasis with normal tapering bronchi is still considered pathognomonic in patients without CF. Elevated serum IgE levels and Aspergillus-specific IgE and/or IgG are also vital for the diagnosis. Mucoid impaction occurring in the paranasal sinuses results in AAS, which also requires a set of diagnostic criteria. Demonstration of fungal elements in sinus material is the hallmark of AAS. In spite of similar histopathologic features, co-existence of ABPA and AAS is still uncommon. Oral corticosteroids continue to be the mainstay of management of allergic aspergillosis. Antifungal agents play an adjunctive role in ABPA as they help reduce the fungal load. Saprophytic colonization in cavitary ABPA may lead to aspergilloma formation, which could increase the severity of the disease. The presence of ABPA, AAS, and aspergilloma in the same patient has also been documented. All patients with Aspergillus-sensitized asthma must be screened for ABPA, and AAS should always be looked for. The Korean Academy of Asthma, Allergy and Clinical Immunology; The Korean Academy of Pediatric Allergy and Respiratory Disease 2016-07 2016-03-17 /pmc/articles/PMC4853505/ /pubmed/27126721 http://dx.doi.org/10.4168/aair.2016.8.4.282 Text en Copyright © 2016 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Review Shah, Ashok Panjabi, Chandramani Allergic Bronchopulmonary Aspergillosis: A Perplexing Clinical Entity |
title | Allergic Bronchopulmonary Aspergillosis: A Perplexing Clinical Entity |
title_full | Allergic Bronchopulmonary Aspergillosis: A Perplexing Clinical Entity |
title_fullStr | Allergic Bronchopulmonary Aspergillosis: A Perplexing Clinical Entity |
title_full_unstemmed | Allergic Bronchopulmonary Aspergillosis: A Perplexing Clinical Entity |
title_short | Allergic Bronchopulmonary Aspergillosis: A Perplexing Clinical Entity |
title_sort | allergic bronchopulmonary aspergillosis: a perplexing clinical entity |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853505/ https://www.ncbi.nlm.nih.gov/pubmed/27126721 http://dx.doi.org/10.4168/aair.2016.8.4.282 |
work_keys_str_mv | AT shahashok allergicbronchopulmonaryaspergillosisaperplexingclinicalentity AT panjabichandramani allergicbronchopulmonaryaspergillosisaperplexingclinicalentity |